Is it normal for an 89 yr old woman who had fractured hip surgery to be in such pain she cannot walk yet with rehab 2 weeks after surgery?

I had hip repair surgery (not replacement) and was not permitted to put full weight on that hip/leg for at least six weeks. I could put partial weight on that leg while using a walker. I was in a lot of pain for several weeks even after weight bearing, but eventually the pain calms down as tissues recover from the surgery.

I think it has something to do with the fact that she is 89

"they think that she is afraid of the pain and that she anticipates before the pain even starts".

Have definately seen this. Physio calls these pts *head screamers* as in the head thinks of screaming regardless of actual pain - mostly nervous worrying types. No shame in it - we all have our own personality type... Is she like that?

If not, I'd be wondering about fractures elsewhere? Pelvis? Femur? Even stress fracture on good leg? (If putting all weight onto it).

**Edit just saw post was Oct - hope she is doing much better now! **

My mom is also 89, fell and had to have a hip replacement surgery on 10/31/19. After surgery they had her up and walking with assistance, everything seemed good. She was discharged from the hospital and placed in a short term rehab facility. Progress has been slow due to extreme pain in her groin area. They have done two x-rays and both have come back clear. Her complaints of pain are falling on deaf ears. The doctor at her facility gives me the impression that he thinks she is just being defiant. She is now refusing PT that requires standing. I am at a loss for how to help. She is taking a mild pain medication. I think she may need something stronger before heading to PT. I wanted to thank you for posting. Prayers that your mom have pain relief soon.

PK1111~I cannot even fathom what that would be like at that age, but I am 61 and found out recently that there is such a thing as HSP: Highly Sensitive Person. My husband and I had the EXACT same surgery on our neck(s) fusing the SAME 3 bones by the SAME surgeon and he was up and running a week later....me, I was in horrible pain for 6 months, and it was almost a year before I 'recovered'. The healing time difference was SO different! My diet is exemplary compared to his, and yet his recovery was fast. Point being that different people recover at different rates and yes, even to extremes. Just sharing for context.

My Mom is still experiencing pain and is still afraid to put weight on it. She had a follow up with her surgeon today and another xray and he says everything is healing fine and that she can put weight on it whenever she is ready. He said because of her age this isn't unusual so we will keep pushing her and we hope as her pain subsides she will push herself harder.🤞🙏

My dad "severely bruised" (Dr. diagnosis) a hip at age 82; went to the E.R. he preferred. Back at home he continued to complain about severe pain. The same night I called the E.R. and spoke to a nurse who said she didn't tell me this, but "Take him to another hospital E.R.". I did. He had fractured that hip and the first E.R. Dr. missed it. Off to re-hab, where he greatly improved, but could not live in independent living again. The gist of this: seek another opinion. Personally I have learned not to discount another person's pain. We simply don't know how much pain another may be in and how their pain tolerance differs from our own. Good luck.

Sedentary life styles can hinder wellness. On top of breaking her hip it may take longer to get better. Prayers sent.💞

Was it a complete hip replacement? My mother broke her hip at age 80. She opted to have pins put in to try to stabilize the break instead of a complete replacement. After a few months she was still having pain so the surgeon went back in and "backed out" the screws thinking that would help. Pain kept up, turns out the head of the femur had died and she ended up with a complete hip replacement after all.

Ummmm yeah!!! My 67yo friend just had hip surgery in august and she’s still in terrible pain and can barely walk!

My mother had hip surgery & was up & walking after a couple days...but she was about 66 yo then . On the other hand, when my Grandma fell & broke her hip, & had surgery, she really didn’t get to walking good after that..she was about 89 or 90 yo . Take her to hip surgeon again for follow up & demand an X Ray. Hugs 🤗

First off, I am really sorry to see what you are experiencing with your Mom. The reason I’m responding is because I have seen both parents at different times suffer with pain. My first question would be are you happy with how her surgery went? My mom has osteoporosis and has fallen and broken bones upon numerous occasions. Is there any way to get your mom an X-ray or second opinion? I know how delicate our mom’s bones can feel at that age and their pain is no joke and so unbearable and I know how heartbreaking it is to see a
parent suffer. My mother suffered with pain for many years and now she is at a point in her life where I’m grateful to God she is pain free. She has been in physical therapy on and off for many years for the fractures she has had. The best thing for pain has been Advil Liquid gels. She has a high pain tolerance and never wanted to take RX pain meds unless absolutely necessary. Hip pain from what I’ve heard is an absolute nightmare and from bottom of my heart I hope she comes out of this pain soon. They can do a lot in rehab, I’ve been very involved with my mom’s treatment teams. They do send them to the rehabs in pain, but they do function like a hospital with the nursing care and the physical therapists can do a lot and move her towards wellness. God Bless!!

My 83 yr old mom fell in our apartment (very minor fall) and couldn’t get up. After surgery for a broken hip and 1 week in the hospital she went to a short term rehab for what was supposed to be 4-6 weeks. Long story short—it’s been 8 months, 3 nursing homes and 4 short hospital stays later and she still can’t walk or stand on her own and doctors can’t find a reason. She became incontinent and acquired rapid onset moderate dementia. (It’s assumed a vascular incident is at the root of her fall and subsequent deline but scans are negative for stroke.). She’s obsessed with learning to walk again and intensely interested in physical therapy so has approached any therapy with a super positive attitude. She really didn’t complain of pain in the hip but had pre-existing chronic pain condition which does play a part. One of the doctors told me that the life expectancy of someone her age who fractured a hip 2 yrs at most.

In your mom’s case I would not rule out fear and/or poor management of pain being a factor because it certainly was/is a component of my mom’s inability to walk. Another possible issue is quality of the facility she’s in. Prior to my mom’s recent transfer to her current outstanding nursing home she was terrified, depressed and mistreated. She was offered no encouragement to walk and wasn’t even given the required minimum number of physical therapy sessions. The longer she went without walking the worse her fear of falling became.

My advice is to address any fears surrounding falls and to check on pain medications she may be receiving. Although pain medication should be given with caution to the elderly, it sometimes does need to be given. In all 3 nursing homes my mom was in prior to the one she finally ended up in, they arbitrarily reduced or cut off her pain medication every chance they had—usually without even telling me although I’m the HC proxy.

Another issue I’ll raise as a potential factor is treatment she’s receiving at the nursing home. I had no idea how badly the elderly are being treated in nursing homes. I live in a major urban city and without exception all of the skilled care facilities were awful —It was just a matter of some being slightly less awful than others. If there’s any doubt about quality of the facility—follow up on it. What was supposed to be 30 minutes of physical therapy daily for my mom turned out in reality to be 10 to 15 minutes daily maybe 3-5 days a week with no additional exercises or encouragement to walk. Nursing notes documented what she SHOULD be receiving—not what actually took place. Maybe I experienced an extreme case but poor treatment at the facilities most definitely impacted my mom’s physical & mental condition. To end on a positive note, I’m her only family member and since we can’t afford private pay, I looked for the highest rated facility accepting Medicaid and moved her 5 hours away from where we lived. Despite considerable hardship to myself I’d say it’s been totally worth it. She describes it as like being in heaven or Disneyland and has already shown improvement. Although I sacrificed a lot to put her there I can now go to sleep with a smile on my face because it’s the happiest she’s been since even before her fall.

Whether my mom walks again or not doesn’t really matter anymore. Quality of life is everything and I believe my mom will reach her full potential now—regardless of what that turns out to be. She knows that she’s finally receiving adequate physical therapy and all the help that she requires and the result so far has been incredible to witness. She knew that she wasn’t receiving good care and it resulted in an obsession with her failure to walk. She still hopes to walk but no longer focuses on what she can’t do. Her days are now filled with things that she has enjoyed and succeeded in doing as well as the future things she looks forward to doing and learning. That’s all one can ask for really.

She may be better suited for postacute rather than subacute of course comorbid sequelae notwith standing.

I had two hips that were beyond destroyed. I entered the hospital and one week apart had both hips fixed. I spent about three weeks in the hospital and another three weeks in rehab before I went home - but for unknown reasons, I did NOT have any pain. Maybe for once I was lucky. Someone has to get to the root of the problem and do something and it may take more than one doctor to figure this out and fix it.

I have read your X-ray results so at least that is negative. When my dad had his various fractures (both pelvic and hip), we found it was very important that he be given his narcotic an hour before the PT so he could tolerate it. Be sure they are managing her pain before she goes to therapy. When they feel she is no longer progressing, then she will be discharged. But first you will have a care conference with the staff involved in her care. From there they will decide where her next move is. I.E., back to IL or into a higher level of care. I would not suggest you take her into your home. They have the facilities there for those whose mobility is limited and are fall risks. You can depend on her probably having another fall at another point. As we always said, it's not if but when dad falls again.

I had total right hip replacement four weeks ago. I’ve had total hip previously on my other hip. This time, very different, agonizing pain the moment I was coming out from anesthesia. When PT got me up a few hours later, wanted me to walk the hall, excruciating pain upon weight bearing. Every single time, and pretty rough pain when not standing. Nursing staff wasn’t properly documenting the horrible pain, particularly on standing. Pain meds did not help. They discharged me home two days after surgery anyhow, to languish in pain, take care of myself, and pets. I hired help to do pet care. Languished first two weeks in pain. Demanded surgeon investigate, as the pain was so abnormal, compared to three prior hip surgeries. He ordered fluid aspiration, pain medication into the new hip joint area. Absolutely no relief. Cultured aspirated fluid, no bacterial infection, thankfully. Next he had me come in for XRay, hip looked fine. Prescribed muscle relaxer, plus steroid pack for inflammation. Bingo! Stretched muscles, spasms, from the hip replacement surgery. I was seen by pain management this past week, and she wants me to stay on the muscle relaxer several weeks, at least. My surgeon lengthened the operative leg slightly, to level out my pelvis, and give enough length, anticipating my old left hip replacement is wearing out. He wants to be able to use a decent thickness cup liner when he revises the old left hip.
Is it at all possible the joint is fine but the muscle has been overstretched, causing horrible pain spasms? There is a tendon, the Iliopsoas tendon, that can cause horrible pain after hip surgery, which is what happened to me. Some surgeons have had to go back in and release that tendon. Would the doc consider a trial of a muscle relaxer?
I feel so bad for your mom. And, yes, anticipating pain makes things worse, but frankly, I don’t blame her, if she’s hurting like I was. My pain was so unnecessary. If only the nurses and doc would have been willing to listen to me complaints of horrible pain.

What does the doctor have to say about this? How about the surgeon? Are you in contact with the P.T.? She may be a slow healer, or she might need another scan to see if something needs to be changed, or a repair surgery. I would asking the above people for answers.

Thank you for your update: that shows that they have done what I was going to suggest you ask about, which is to check that all was well with the surgical repair - and it is.

All the same, this isn't exactly *normal*, but then where the pain is coming from does depend on what condition your mother was in before the fall-and-fracture, and it sounds as if the bruising that can't be helped with such major surgery, and her bone frailty, and her being unused to exercise put together could mean that she's rediscovering muscles she'd forgotten she had - and they hurt! Poor lady.

I should encourage her to persevere, because with time and good, consistent rehab things should improve tremendously.

A replaced hip might be weight bearing right away, but a pinned hip needs at least 6-8 weeks of partial weight bearing first. I had a hip "pinned" and was not permitted full weight bearing for 6 weeks. I had PT and OT and CT in a Rehab facility for 30 days then continued PT and OT at home until doctor re-xrayed at 6 weeks and approved full weight bearing. There was severe pain during the entire 30 days of Rehab and for some weeks after getting home.
Rehab exercises will increase the pain beyond what it might have been the first few days after surgery in the hospital, and some of that is normal, but you need to be sure there is not still an unrepaired fracture or crack in the hip or pelvis. Would an MRI be called for if x-ray does not find anything?

My 86-year-old mom fractured her hip last July. After being in a nursing facility for a while they sent her home with some pain medication which did not really give her relief for the pain (Norco). A couple of weeks later she was in horrible pain again and could not even stand. She was transported by ambulance back to the nursing facility. This time the physician prescribed Percocet for pain, and Cymbalta for depression/anxiety/pain management. The combination of the stronger pain med and the anti-depressant helped her. Two months later she is walking pain free and without pain meds. She still takes the Cymbalta. I hope our story might be of some help to you.

When my friend broke his femur at his hip, he had to have major surgery to have pins and rod put in. The pain was excruciating. The Drs said it was completely weight bearing. They had to use the sling for the first couple weeks in rehab before graduating to a sit and stand. The problem I figured out is the nursing/Cna staff are really busing in rehab and the PT’s would come get him before the nurse would give him his pain pills. I absolutely forbid the PT’s to take him to therapy without his pain meds given a half hour prior. I sat on their backs every single day. Bottom line is he went from AL memory care to skilled care when rehab was finished. He continued to get some rehab in SNF but not enough to go back to AL. Anesthesia caused his memory test score to go from a 14 to 6. So what I am trying to say is make sure she is getting enough pain meds and that they are given a good half hour or more prior to PT. Best of luck.

PK, please find out if there is a geriatric psychiatrist who visits at the subactute rehab facility. If this is truly anticipation of pain and not "actual" pain, then mom might benefit from meds for anxiety/depression/agitation that will get her over the hump.

No

I was able to review the results of the xray on her medical portal and here is what the results said:
HISTORY: Prior fracture status post repair, increasing pain.
Frontal view of the pelvis as well as AP and frog-leg images of left hip are
provided.
COMPARISON: September 29, 2019.
Bone mineralization is diminished. There is left-sided hip nail in place. No
new fracture. No evidence of hardware displacement. Pelvic ring is symmetric.
IMPRESSION: No new abnormality identified.

They said she can bear as much weight as possible. We are seeing very small changes as to how she moves with less screaming and moaning...she still seems afraid of the pain however...I pray her new therapy will help...

I pray that the pain subsides for her soon...

Well we moved my Mom to the sub-acute today. She was agitated because she is in a shared room with her room-mate in a bed directly across from her so we just pulled the curtain. I have never seen my Mom like this she usually is light hearted and friendly. We did have the hospital give her an xray before we left and they said it came back ok and everything looked fine with her surgery and no other probelms. I guess at 89 years old you just don't pop back and this pain is really hard on her. I truly feel she is in the right place now with a team of therapists that specialize in geriatric patients and they will with time help my Mom get back on her feet. Right now though she is still totally dependent and it's so hard to watch her in pain. Thanks everyone for listening!!

Thanks Barb! Its been so very stressful. I am heading to the hospital and just a little bit and we are moving my mom today. I will let everyone know how this plays out thank you all for your advice and concern it means a lot!

I would request an xray. I had a good friend who had a total hip. She got up on the commode, got off and had instant pain. They ignored her two days and then went to xrays and it had dislocated. They knew eventually by the spasms of muscles in the whole leg. I would try for an xray before discharge. This doesn't seem right to me. What do the PT people tell you? They are the BEST diagnositicians on something like this, SO MUCH BETTER than doctors or anyone else.

PK, another thought has occurred.    The therapy she's being given might not be appropriate for her, i.e., if she has to be weight bearing on that leg, it might be too much to put pressure on it.

There are other exercises an experienced and compassionate therapist can give her to build up her leg strength before putting pressure on it. 

We had a similar problem when my mother fractured her leg.    I wrote about it on another thread, but don't remember which one, so, just briefly, Mom was in a non weight bearing situation, but the therapist prescribed exercises that required standing and were too aggressive.  We intervened, the therapist was transferred, and Mom got another very sensitive and compassionate therapist...and improved.

So sometimes the therapist just isn't compatible with a particular patient.

I think getting another x-ray is absolutely the best way to go to sort out the situation.   And I would raise the pain issue with the doctor as well.    There may be other issues in play.

Thanks everyone I have asked the nurse to get the Drs to approve an Xray just to make sure. She is scheduled to leave here tomorrow but my hopes are that they do the Xray and let us know the outcome by morning. I would feel terrible if I keep pushing her and there was something else wrong. Thanks everyone for the suggestions! Ps. She does have a touch of dementia so if the Xray comes back ok I am going to place much emphasis on her having to do that therapy so she gets to go home.